J Korean Med Sci.  2024 Nov;39(44):e281. 10.3346/jkms.2024.39.e281.

Diagnostic Value of Sternocleidomastoid Muscle Hemorrhage on Clavicular Periosteum in Hanging Deaths

• Lim S
• Chun Hr
• Kim MK
• Son MJ
• Kim C
• Yoo SH

• KMID: 2561433
• DOI: http://doi.org/10.3346/jkms.2024.39.e281

Abstract

Background
Suicide remains a significant global public health challenge, with hanging as the most prevalent suicide method in South Korea. This study aimed to determine diagnostic markers confirming suicidal hanging-associated deaths.
Methods
In this prospective study, hemorrhages at the periosteal-clavicular origin of the sternocleidomastoid (SCM) muscles were compared among suicidal hanging, manual strangulation, and ligature strangulation cases. This study included 211 cases of suicide by hanging, and a control group of 50 individuals who underwent cardiopulmonary resuscitation but died of other causes. Additionally, nine cases of ligature strangulation and six cases of manual strangulation were analyzed. Postmortem examinations were conducted, and clavicular hemorrhages were histologically evaluated. Statistical analyses were performed using the χ² test.
Results
Hemorrhages at the periosteal-clavicular origin of the SCM were observed in 178 of the 211 hanging cases (84.4%). The highest frequency of clavicular hemorrhage was found in typical hanging cases with complete suspension. Among the 50 control cases, only three showed hemorrhages in the clavicular region, but these were extravasations in the adjoining soft tissue, not in the periosteum. In cases of manual and ligature strangulation, SCM hemorrhages were found within the muscle tissue and were not of periosteal-clavicular origin.
Conclusion
Hemorrhage at the periosteal-clavicular origin of the SCM is a significant finding in suicidal hanging and serves as a potential pathognomonic marker for confirming cases of suicidal hanging. The study revealed a statistically significant association between the type of hanging, completeness of body suspension, and the occurrence of these hemorrhages. Cardiopulmonary resuscitation does not cause a hemorrhage at this location.

Keyword

Hanging; Suicide; Sternocleidomastoid Muscle; Hemorrhage; Clavicle; Forensic Pathology; Strangulation

Figure

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  Fig. 1 Periosteal hemorrhage (indicated by blue arrows) at the clavicular origin of the right sternocleidomastoid muscle in cases of suicidal hanging.

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  Fig. 2 Classification of hanging types according to knot position: typical (posterior) and atypical (anterior, right lateral, and left lateral).

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  Fig. 3 Distribution of clavicular hemorrhages by type of hanging.

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  Fig. 4 Distribution of clavicular hemorrhages by body suspension.

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  Fig. 5 Hemorrhages at the sternocleidomastoid muscles (indicated by white arrows) in victims of manual strangulation.

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